Tuesday, May 26, 2009

I want to ask a question about goodness, or at least about good intentions. The shocking revelations about MPs’ expenses have made me wonder how it is that we have so many villains as public servants. I know a few politicians and from my personal interactions with them they seem to be honest men with a high sense of public service. There is a public mood at the moment that all politicians are crooks and the sooner they are set before a judge and jury the better. The European and local elections are due in a couple of weeks and the current mood says whatever you do, don’t vote, it only encourages them. If we follow that instinct we will find ourselves ruled by extremists, for certainly the very committed won’t abstain, and the very committed are often committed to extreme policies.

Let me first say that I don’t believe that any man is perfect. I believe in original sin, and therefore I am not dismayed to find that a man set on a pedestal has feet of clay.

As far as the MPs are concerned, it now appears that they were encouraged to lie and cheat by a central office of expenses presided over by the Speaker of the House (he is an ex-shop steward for the sheet metal workers) who seems to have set himself up as shop steward for MPs. The central fees office seems to have taken the view that MPs were not simply claiming expenses, but were receiving a special tax-free allowance in lieu of a salary increase. I remember a similar culture in business in the 1970s. I was speaking at a meeting in Spain. I had been funded for the meeting by an equipment manufacturer (they paid my airfare and hotel costs). They told me that the regulations did not allow them to pay me a fee for my services, but they would be generous with expenses. I did not understand what they meant by that so they spelt it out. “You may have a letter to open so you might need a letter opener. You might therefore take a trip to the jewellers and purchase one with a gold blade and diamonds in the handle.” In the event I did not feel that I could do such a thing with an easy conscience and I declined.

At least three MPs have been found claiming for repayment of mortgage interest long after the mortgage had been repaid, but this is just the tip of the iceberg. It is indeed reasonable for someone who has to live both in constituency and London, to be reimbursed for the extra cost of doing so, but as one MP commented you may have two homes, but you’ve only got one belly, and to claim for food consumed at your second home seems unreasonable. Having a second home is open to abuse and it seems that MPs have used every dodge in the book to enhance their private income. While many of them have not broken the rules, they all appear greedy; as if these people who claim to be politicians for the public good are in fact only concerned about their private good.

How is it that people with good intentions find their good intentions paving the road to hell?

This is not the first time our politicians have been caught out. Tony Blair seemed to be a breath of fresh air after the sleaze that seemed to pervade the ’18 years of Tory misrule’ as it was called. Yet he misled Parliament over the Iraq war and signaled his dishonesty by accepting a bribe on behalf of the Labor Party from the Motor Racing chief in order to allow tobacco advertising to remain on racing cars in his very first week of power. Politics is a dirty game and compromise is its name. American legislators like their slice of pork before agreeing to anything. Only this week the British Medical Journal reports of the effect of putting a minimum price of 50 pence a unit on alcohol. It would save more people’s lives than are killed on the roads every year. Yet the government would not countenance it, such is their cosy relationship with the brewers and distillers.

In the Letter to Titus chapter 3 Paul tells him to “Remind the people to be subject to rulers and authorities, to be obedient, to be ready to do whatever is good, to slander no one, to be peaceable and considerate, and to show true humility toward all men.”

Good advice! But putting it into practice is an awesome task. Why is it so difficult? We assume that people are naturally good, so it shouldn’t be difficult. However, Paul goes on: “At one time we too were foolish, disobedient, deceived and enslaved by all kinds of passions and pleasures. We lived in malice and envy, being hated and hating one another.” When it comes down to it, we aren’t naturally good; we’re naturally bad. We tend to compare ourselves with murderers and rapists and drug dealers and say, “We’re not as bad as that!” But why chose such a comparator? Are you as good as Mother Teresa in your self sacrifice? She wasn’t good enough! Are you as good as Bill Gates in your charitable giving? He isn’t good enough! Are you as good as Lord Shaftsbury, or William Wilberforce, or Florence Nightingale, or Elizabeth Fry, or Abraham Lincoln, or Hudson Taylor in their various attempts to improve the world? None of them was good enough, nor would they claim to be.

I used to tell people in the Health Service that you could get anything done as long as you didn’t want the credit for it. The first step to doing good is self-abasement. Jesus told of the Pharisees who sent a trumpeter out ahead of them to play a fanfare to announce their good works. “Verily, they have their reward!” But the Bible tells us that all our righteousness is as filthy rags, and so it is. There used to be a TV advert set in India where a young man got an elephant to sit on his old Simca to squash it into a similar shape to the new Peugeot 107. Such a bashed up old vehicle is a potent symbol of our attempts to mimic the righteousness that God demands. Tawdry and risible are our tries. Without an admission of our hopelessness we can get nowhere.

Paul continues: “But when the kindness and love of God our Savior appeared, he saved us, not because of righteous things we had done, but because of his mercy.” We are smothered in God’s goodness when we accept the Savior. It is only when we have the humility to accept this that we can begin. Some people have a swaggering satisfaction that they are the chosen ones, the elect of God, or even the Israel of God. They see themselves as having some superiority – even if they don’t know how to define it. There is a chorus that we sing that goes, “I’m special, because Jesus loves me.” In a sense that is true and in a sense it is insanely untrue. Just think how the world looks at you when you go around singing, “I’m special.”

He did not choose to save us because of anything special he saw in us, even something that he saw and we cannot define, and certainly not because of our goodness or our potential or our obedience. It is a mystery why some are effectually called and some are not, but it is certainly not because of any sort of merit. And it is certainly not our place to disparage anyone else he effectually calls.

Paul continues: “He saved us through the washing of rebirth and renewal by the Holy Spirit, whom he poured out on us generously through Jesus Christ our Savior, so that, having been justified by his grace, we might become heirs having the hope of eternal life.” (verses 5b-7). The work of the Holy Spirit in our lives is a great mystery, but it is what makes us truly alive. The Spirit is like light; you cannot see light, only what the light illuminates. Similarly, you cannot see the Spirit, only the effects He makes on people’s lives. Many Christians will tell you that they have never had any special feelings to denote the presence of the Spirit, no tingling, no ‘high’, no emotional peak; yet ask those who know them and they will tell how they display kindness, faithfulness, gentleness, self control, love, joy, peace, patience and goodness. These are not natural gifts; no-one is like that by nature; these are the fruits of the Spirit.

It is justly emphasized that it is the Spirit who gives us new birth, new life, indeed eternal life. But Paul continues: “This is a trustworthy saying. And I want you to stress these things, so that those who have trusted in God may be careful to devote themselves to doing what is good.” (verse 8). The Spirit’s activity is not just confined to our future, but also to our present – and our present is devoted to doing good. “These things are excellent and profitable for everyone.”

Again in verse 14 Paul emphasizes, “Our people must learn to devote themselves to doing what is good, in order that they may provide for daily necessities and not live unproductive lives.” This is the normal Christian Life. What was it about Wilberforce and Wesley, and Booth, and Hudson Taylor, and Dr Barnardo, and Elizabeth Fry, and Florence Nightingale, and Lord Shaftsbury, and so may others who have done great works of generosity to their fellow men, who have righted great wrongs, stood up for the poor, the persecuted, the downtrodden? It is the life of Christ in the heart of men. It is the Holy Spirit working his purposes out as year succeeds to year. Oh, I know it isn’t only Christians who do good in the world. The Bible acknowledges that. Cyrus, the Persian king, was God’s instrument while he was certainly no believer. In Isaiah 44 and 45 we read: [God], who says of Cyrus, 'He is my shepherd and will accomplish all that I please; he will say of Jerusalem, "Let it be rebuilt," and of the temple, "Let its foundations be laid. This is what the LORD says to his anointed, to Cyrus, whose right hand I take hold of to subdue nations before him and to strip kings of their armor, to open doors before him so that gates will not be shut.” In His common grace there will be many who will unknowingly be God’s instrument, whose right hand will take hold of. A story is told of a man visiting a church who complained that Enid, a old woman in the church was a gossip, a shrew and a complainer. “I know a woman down my street who is kind, helpful and pleasant, who never darkens the door of a church and thinks all religion is poppycock.” The pastor replied, “But you should have seen Enid before she became a Christian.” Of all true Christians we may be sure that when the Holy Spirit gets to work on them, they will be better than they were before.Goodness is not a way of salvation; it is a consequence of salvation. We don’t do good works to impress others, or to earn merit, or even to improve the common weal. It is the love of Christ that compels us – both the Holy Spirit within and our intense sense of gratitude for what we have been give.

Saturday, May 23, 2009

I spent most of yesterday and most of today so far dozing. For some of the time I was dozing in front of the TV watching old movies, The Asphalt Jungle and Kirk Douglas in Detective Story, but otherwise I was just dozing. I have started the latest Lee Child thriller, but even thrillers can't keep me awake. This must be chemo-brain. That and the fact that I have already made eleven typos just writing this. Make that 13. Shan't write anymore today.

Thursday, May 21, 2009

Results of particular treatments are usually reported as median survivals. This means the time at which 50% of people are dead and 50% are still alive. Medians are sensible figures when calculated on populations based on a normal distribution as represented by my second curve. But survival curves, as can be seen from the first illustration, do not look like this. They are extremely right skewed.

The median of the whole population is pressed up against the left hand edge of the graph at zero days because the normal distribution would contain all those who were going to get the cancer that we don't (and can't) know about. So we start on the downward slope from the time that the cancer is diagnosed. But that is a time some way into the disease. Some people are only diagnosed on the day that they die, having had the disease for many years undiagnosed. For CLL, we know that virtually all cases have had a long period when they had MBL before the diagnosis was makeable, and even when the diagnosis was makeable with a blood test, most people don't have blood tests.

On the survival curve, those with the most advanced and drug-resistant disease die soonest. By the time you get to the median survival the survivors are mainly those who had good prognostic factors at the beginning: low white count, no lymph nodes or spleen, mutated IgVH genes, low ZAP-70, low CD38 and del 13q14 on one chromosome. We know that some patients with these characteristics live out beyond 20 years and that they tend to die from old age. Indeed the ACOR list reported a man in New Mexico who had had the disease for 52 years. That survival curve had a very long tail indeed. As far as CLL is concerned the tail is abbreviated by the fact that everybody dies and that CLL patients cannot live longer than life itself. It is also a snapshot of the time it was drawn and it cannot take account of treatments that will appear in the next 20 years.

As far as my cancer is concerned, the median survival on this treatment is given as 22 months. But the 50% who die in this time are those who are really ill when they present, including those with massive liver secondaries, ascites, and bowel obstruction. I have all the good prognostic features: a primary so small as to be unfindable, localized spread, no liver involvement and no ascites, a well differentiated histology, low CEA levels, no symptoms and a 6 month observation which showed no progression on the CT scan. I should be on the right hand edge of the tail of that survival curve.

After the fourth course I felt very tired and had to take a 30 minute nap. Of course I still have the 46 hour infusion of 5-FU to get through. Yesterday, in pursuit of the positive attitude, we decided to go for a walk in the middle gardens in Bournemouth. I had better explain that. The Bourne brook runs into the sea at Bournemouth (that's how it gets its name). Bourne is an old English word meaning stream or brook, so it is a bit redundant to talk about the Bourne brook. Anyway the Bourne is never more than 5 feet wide, and where it enters the sea they have built the Lower Pleasure Gardens. This has the usual seaside attractions, like crazy golf, a ride in a balloon, an aviary with budgerigars and canaries, a bandstand, an area for sunning yourself on the grass, the Pavillion Theatre, and seawards is the pier with an end of pier theater and an amusement arcade. The Lower Pleasure Gardens are sandwiched between the sea and the Square which is the largest shopping center in Bournemouth. If you like the bustle of a large city you will find it there, but we came seeking peace and quiet.

Bournemouth is famous for the chines, valleys that cut through the cliffs at regular intervals. Usually they are planted with pines and provide sheltered walks in the hot summer. In one of them, Alum Chine, there is a short suspension bridge spanning the chine. It is famous because Winston Churchill fell from it when a boy and was unconscious for several days.

The longest chine is Bournemouth Chine, which is much wider than the others and extends a couple of miles in land. The gardens, now known as the Middle Gardens and the Upper Gardens are the extension of the Lower Pleasure Gardens, and of course the Bourne runs through them until you reach Coy Pond, which I have written about before. Deserted, except for a few old fogies like ourselves, these gardens are a delight. Planted with trees and shrubs on either side of the brook, this is a wonderful time to view them. The Rhododendrons and Azaleas are in full bloom with many different bright colors, but a slow walk reveals many other blooms to identify. You almost need a guidebook there are so many different species. The viewing is accompanied by the songs of blackbirds and thrushes and a rest on the seats allows the identification of many other species of bird. We watched a couple of jackdaws pecking away at the grass.

It was warmish in the sun, perhaps mid-sixties, but then the wind blew I got the cold-induced pins and needles on my face. This was an unpleasant reminder of my circumstances, but a signal that it was time to get into a warmed car and drive on.

Once home it was back to the TV for the latest episode of 24 and then an old movie "Support Your Local Sheriff". Sad to see how James Garner has aged now, in his prime he had a laconic, laid back attitude that suited perfectly this spoof Western.

In December, we took a trip to San Francisco. In retrospect Bournemouth is a better destination for holidaymakers like us.

Tuesday, May 19, 2009

Today I start my fourth course. When I finish this I will be a third of the way through. looking back, the third course was the worst so far. Not in terms of the side effects which I am beginning to come to terms with, but more because of my mental state. I was beset by doubts as to whether the chemo would be effective, of whether I could possibly last six months of this and of whether the side effects would ever remit. I would not say that I was depressed, but I cam pretty near to it.

As it is I feel better this morning and ready to start again without dose reduction. The remaining symptom is a sore nose for which I am applying naseptin. I have not really been blogging much, and to cap it all I have lost my internet connnection. I am using my daughter's computer for this blog

Sunday, May 17, 2009

I think I ought to comment on the scandal involving Members of Parliament. For my non-British readers I should say that the newspapers have been full of nothing else for the past week. MPs are paid in a complicated way. They receive a salary of about $82,000 and on top of this receive about $150,000 for office expenses. More than 20 years ago they were pushing for a pay rise which the government of the day did not want to give them. The government devised a way in which they could receive more money without appearing to. Since MPs have duties both in London and in their constituency it was agreed that they should be able to be reimbursed for a second home, either in London or in their constituency. What has happened is that some MPs have been abusing the system.

At first there were a few leaked documents that revealed that it was quite common for MPs to employ family members as office assistants. Sometimes there is nothing objectionable about this; a spouse may be as committed to the family business as the principal, and ought to be remunerated. However, Derek Conway (Tory MP) was caught putting his son, a university student, on the payroll while he made only a token contribution to the work of his father. Conway was punished by being expelled from the Tory party. Others felt that prosecution for fraud might have been more appropriate.

Still, this put the whole parliamentary system of expenses under suspicion, and journalists sought to obtain access to MPs' claims under the Freedom of Information Act. MPs did not like this and sought to exempt MPs' own documents from the Act. When this was not granted, the MPs then attempted to appeal this decision at the High Court, spending £50K of taxpayers' money on lawyers' bills. They lost this too. Finally they agreed to publish expenses, but said they would need time to censor sensitive information (addresses, telephone numbers etc). Clearly the plan was to censor anything that might be embarrassing. Somebody though this too much so a computer disc with the uncensored information found its way to the Daily Telegraph (rumoured to have been sold for up to half a million dollars).

The Telegraph has been drip-feeding the information into the public domain for more than a week. The stories have been startling. Remember that the rules state that expenses are allowable for cost incurred solely for carrying out their duties as MPs. Reasonable expenses might be for rent or mortgage interest on a second home, maintenance costs of such a home, travel, and extra food costs. Such reimbursement of expenses is commonplace in business and indeed in the public sector. If I were required to attend a committee meeting in London I would expect my train fare to be paid; if I had to stay overnight to make an early start, I would expect a night's stay in a hotel to be paid for (and in Central London that would be about $140). In addition, I would expect to be fed while I was away from home - usually a sandwich lunch provided at the meeting and a hotel meal in the evening (no more than $40 in central London).

What we have seen is the process of 'flipping'. This means that an MP will nominate a London home as his secondary residence, claiming 'maintenance' costs that upgrade the residence (such a new kitchen and bathroom) then 'flip' his nomination to his constituency home where he will do the same. He will then sell his London home at a profit, buy a new derelict property, upgrade that at taxpayers' expense and then 'flip' again. Each time he sells and re-buys he makes a smart profit - or he might just keep the upgraded house and become a landlord. Normally, one would have to pay 40% Capital Gains tax on selling a second home, but by manipulating the nomination of what is the secondary home it is possible to avoid this.

Although this has been the commonest abuse there have been many others. Many have equipped their London homes with luxury goods like 42 inch plasma screen televisions or state of the art Hi-Fis. Some have nominated their country estates as their secondary homes and put in claims for cleaning of their swimming pools, drainage of their tennis courts and even (hard to believe) dredging of their moat. Some MPs have been regularly claiming their complete grocery bills ($600 a month on their Walmart bill).

As you may imagine the public are very angry. Their taxes funding luxury goods while their jobs are in jeopardy, their pensions are dwindling and their houses being repossessed is hardly going to endear MPs to their constituents.

David Cameron, the Tory leader has taken the initiative, forcing some of his MPs to repay their more extravagant claims, and dismissing one MP from his front bench for dishonesty. Gordon Brown has sacked a minister and expelled two MPs form the party, but the scandal is hitting Labor more than the Tories. Two Labor MPs look to be liable to prosecution for fraud after claiming mortgage repayments on houses where the mortgage had been repaid. It looks like they are going to take a real hit in the next election.

My own solution would be to drastically reduce the number of MPs - 646 for a nation only one fifth the size of the USA seems extravagant - and pay them proper salaries. Only legitimate expenses with receipts should be reimbursed.

Friday, May 15, 2009

Side effects this time seem to have lasted longer. One that I have not had before is associated with meals. After eating, I feel faint and shocky so that I have to lie down. I have a rapid pulse and start sweating. I also get strong bowel activity with rumbling noises. This all sounds very like the dumping syndrome seen after gastric surgery. I am guessing that it is caused by damage to the intestinal mucosa by 5-FU that allows simple sugars to pass rapidly into the blood stream, and this causes a release of insulin. Presumably the remedy is to eat food with a low glycemic index. No more mashed potatoes and French Fries.

Thursday, May 14, 2009

On June 6th 1944, British, Canadian and American forces landed on the beaches of Normandy. A second front had been opened in the Second World War. From then on defeat of the Axis powers was assured. The suffering was not over by a long shot, but victory was certain. 'Saving Private Ryan' graphically illustrated the deaths on the beaches. 'Schindler's List' demonstrated what was going on in the concentration camps. ‘The Battle of the Bulge’ reminded us that Germany still had teeth. V1 ramjets and V2 rockets continued to rain death on civilians in London; there was a lot of suffering still due.

For the Christian, the position is similar. Christ has defeated Satan. Victory is assured, but the suffering continues. There seems to have grown up a Christian tradition that all a Christian receives on conversion are blessings. Of course, Abraham was promised great blessings, having believed God, but in the great chapter 11 of the letter to the Hebrews, we read that "These were all commended for their faith, yet none of them received what had been promised." (verse 39). The final blessings are reserved for the return of Jesus Christ. Jesus himself promised that in this world we would have tribulation, but we were to take heart, because he has overcome the world! (John 16:33)

Christians do suffer

About suffering: it is the testimony of all true Christians that this life will not be an easy passage. The early Christians suffered persecution at the hands of the Jews and the Romans. The secular powers have always persecuted Christians; in our own lands in the middle ages and today in places like Iraq, Afghanistan, Orissa, Iran and many other lands. Moreover, it was predicted by Jesus: "If the world hates you, keep in mind that it hated me first. If you belonged to the world, it would love you as its own. As it is, you do not belong to the world, but I have chosen you out of the world. That is why the world hates you. Remember the words I spoke to you: 'No servant is greater than his master.' If they persecuted me, they will persecute you also." (John 15:18-20). Indeed, Paul, writing to Timothy suggests that persecution is inevitable: "In fact, everyone who wants to live a godly life in Christ Jesus will be persecuted" (2 Timothy 3:12) and in The Acts he says it again: "We must go through many hardships to enter the kingdom of God," (Acts 14:22).

But that is about persecution; what about other kinds of suffering? Sometimes we suffer because of our own silly fault. If we crash out motor bike at 100 mph, we can hardly blame anyone else; if we suffer from tertiary syphilis or AIDS as a result of 'sowing our wild oats', who is to blame but ourselves? If we are sent to prison for bank robbery we can hardly complain that God is treating us harshly. "It is better, if it is God's will, to suffer for doing good than for doing evil." (1 Pet 3:17). Nevertheless, sometimes we suffer from natural disasters or illnesses that are none of our doing. Sometimes we rage against God for not protecting us from these. Are we not entitled to live a charmed life that avoids these 'snakes' and to expect a life that consists only of 'ladders'?

I see no promise that we will be kept from natural disasters. We will be subject to trials and temptations, including the temptation to despair at our sufferings, for as Paul's first letter to the Corinthians states in this quotation from the Amplified Bible: "For no temptation (no trial regarded as enticing to sin), [no matter how it comes or where it leads] has overtaken you and laid hold on you that is not common to man [that is, no temptation or trial has come to you that is beyond human resistance and that is not [a]adjusted and [b]adapted and belonging to human experience, and such as man can bear]." (10:13) In other words we are not excepted from "the slings and arrows of outrageous fortune". God makes it to rain upon the just and the unjust.

These evils are in the world as a result of Adam's sin; Adam, that perfect man created in the image of God with greater physique, intellect and knowledge of God than any of his descendants, (lest you think you would have done better) who brought us all down by disobeying God. Romans chapter 8 spells out for us the wretched state of both ourselves and the whole creation: "The creation waits in eager expectation for the sons of God to be revealed. For the creation was subjected to frustration, not by its own choice, but by the will of the one who subjected it, in hope that the creation itself will be liberated from its bondage to decay and brought into the glorious freedom of the children of God. We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. Not only so, but we ourselves, who have the first fruits of the Spirit, groan inwardly as we wait eagerly for our adoption as sons, the redemption of our bodies" (vv19-23).

That bondage to decay afflicts us yet; what better description for worn out hips or cancerous intestines?

The suffering is real

So Christians do suffer. My second point is that suffering is real. Sometimes Christians make light of their suffering as if it belonged to another unreal world. They live on a Spiritual level, where bodies have no reality; though they may wince at pain, they try to convince us that they do not really feel it. How many times will Tom have his head hammered into the ground by Jerry and still be able to bounce back to chase once more that pesky mouse around the garden? This cat has more than the specified nine lives. The sufferings of Christians are not some sort of cartoon violence. Would you dare to think of missionary, Graham Staines and his two boys incinerated in India ten years ago, not really feeling the pain of his martyrdom? Would you suggest it to his widow and his daughters? Christians thrown to the lions or ignited as human floodlights for Nero's delight were not given some sort of sanctified anesthetic. It was real pain. Those who mourn suffer real heartache. Those who worry over a spouse's illness lack real sleep and have real gut-wrenching anxiety.

It is not just experience that tells us so. There are a many, rather strange references in the New Testament to sharing in the suffering of Christ: “Dear friends, do not be surprised at the painful trial you are suffering, as though something strange were happening to you. But rejoice that you participate in the sufferings of Christ”. (1 Peter 4:12-14); “For it has been granted to you on behalf of Christ not only to believe on him, but also to suffer for him”. (Philippians 1:29); “Now if we are children, then we are heirs—heirs of God and co-heirs with Christ, if indeed we share in his sufferings in order that we may also share in his glory” (Romans 8:17); “I want to know Christ and the power of his resurrection and the fellowship of sharing in his sufferings, becoming like him in his death” (Philippians 3:10).

If the sufferings that we share with Christ are dream-like, unreal or cartoon replicas, then Christ's suffering was unreal too. It implies that on the Cross he was out of the body, that the lashes found no resistance on his flesh because no-one was at home, that the nails sliced through his wrists without conveying pain because no-one was listening to the signals from the nerves there, that the crown of thorns was whacked down by the soldiers but was not noticed because he was elsewhere, cocooned by Angels in celestial bubble wrap, inured from harm.

What a travesty! What a calumny! I once heard a sermon by Greg Haslam that offended most of his hearers because they thought it exaggerated the brutality of the Cross. Many have criticized Mel Gibson's "The Passion of the Christ" for its 'glorification of torture'. It is impossible to exaggerate what took place at Calvary. No doubt the scourging was desperately painful (I was caned twice at school - I can't imagine what it would have felt like to have my flesh torn from my back at every blow). Carrying a heavy cross through the streets of Jerusalem was too much for his frail frame - no Angel stepped in to bear it for him, just a pressed man there for the spectacle. The nails, the crown of thorns, the hanging for hours, the thirst, the constant lifting of the body weight on pierced ankles just to catch another breath - these were all body-borne agonies; but more than this the splitting asunder of the Godhead, the Trinity sundered, when every punishment for sin was heaped upon him is incomprehensibly awful. Greg Haslam compared it to every pain of every cancer heaped on his body, but it was more than that. I think at the time I was having trouble with Isaiah 53:4 in Young's literal translation: "Surely our sicknesses he hath borne, And our pains -- he hath carried them, And we -- we have esteemed him plagued, Smitten of God, and afflicted"; with the implication that a word from Jesus heals us. Greg tended to be on the Charismatic wing.

The word translated 'sicknesses' is elsewhere translated 'griefs', 'infirmities', 'weaknesses' or 'distresses'. All these and more were poured out upon our Savior but the greatest distress was the separation from his Father God. When my children were born I was beside my wife, holding her hand. I don't know whether it gave her much comfort, but while I was recently in hospital recovering from surgery and suffering dreadful, eye-watering, colicky pain, the only comfort I received was for her to silently hold my hand and squeeze it; letting me know that we were sharing it together.

As Jesus suffered on the Cross there was no-one to hold his hand, no-one to wrap their arms around him, no-one to give him succor.

Sharing is not adding

Dr Helen Roseveare, once a missionary in the Congo, tells of the occasion that she was raped by the rebels. She reports a vision of the Lord Jesus appearing to her and telling her that he had need of her body to suffer in. I would not dream of denying her vision, nor of depriving her of the comfort that the thought brought during her terrible ordeal, but we are on dangerous theological ground here. There must be no suggestion that the suffering of Jesus on the Cross was not complete. Hebrews 10:12 tells us that "When this high priest (ie Jesus) had offered for all time one sacrifice for sin, he sat down at the right hand of God" (ie he had completed his work). No more suffering was required to take away sin. The resurrection also signifies that the work is complete.

So in what sense can we be said to be sharing in the sufferings of Christ? I believe it means that we are becoming more familiar with the sufferings of Christ. Our sufferings do not win souls or save sinners, but as we suffer we begin in an infinitesimal way to suffer in like manner to Jesus, we better understand what it cost him to save us. That is why Paul counted it a privilege.

Is there any advantage to being a Christian as we suffer?

A certain future

Yes, there are advantages. It doesn’t hurt less and we are not spared the possibility of dying, but in the first place we have the assurance that we serve a just God who has made our future certain. “If indeed we share in his sufferings … we may also share in his glory.” (Romans 8::17. and these sufferings “are not worth comparing with the glory that will be revealed in us.” (verse 18). “For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all”. (2 Corinthians 4:17) “But rejoice that you participate in the sufferings of Christ, so that you may be overjoyed when his glory is revealed.” (1 Peter 4:13).

Most mothers forget their labor pains when they hold the little one to their breast. No-one will hark back to their earthly travails when the glorious Son of God returns in triumph in the clouds surrounded by the glorious dead, as the dead in Christ rise to meet him in the air and the trumpets sound the victory salute. We will rejoice with the Angels as we look on his face.

A changed outlook

The second advantage is that we will be changed by our sufferings. The Bible talks about being refined by fire. Paul tells us that “suffering produces perseverance” (Rom 5:3). Discipline is not a popular subject these days. To welcome discipline has kinky overtones, suggesting something perverse to do with Miss Whiplash, but the Bible tells us that those whom God loves, he disciplines (Revelation 3:19; Psalm 94:12, and 119:75; Proverbs 3:11-12). It is clear from Hebrews chapter 12 that the discipline being talked about is physical punishment such as a strict father might inflict on a wayward son. “No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it” (Hebrews 12:11)

This teaching is hard for us to accept. We have become used to modern medicine. There seems to be a pill for every ill. If it is too cold we turn on the central heating; too hot and we turn on the air-conditioning. The rain finds us inside our dry houses or dry cars. From thunder and lightning we are protected. Our houses are built to withstand hurricanes and earthquakes. We don’t go hungry or thirsty. Our police forces are expected to protect us from murder, robbery and mugging. We are outraged if our authorities were to torture our enemies let alone its own citizens. Shipwreck is a rare event; piracy only happens to other people; what is there to harm us? We expect a smooth passage through this life and if a father dares to chastise a child someone will yell, “Abuse!”

Yet people do learn from hardship. Alas, only sometimes. This teaching on discipline seems to be saying to us that we, as Christians, must learn from hardship. Instead of whingeing about how badly we have been treated, we should seek to learn lessons from our adversity. One lesson I have learnt comes from Ecclesiastes 4:9-12: “Two are better than one, because they have a good return for their work: If one falls down his friend can help him up but pity the man who falls and has no one to help him up! Also, if two lie down together they will keep warm but how can one keep warm alone? Though one may be overpowered, two can defend themselves. A cord of three strands is not quickly broken.”

Spiritual warfare

Job was never told the reason for his suffering; he was just made to understand that God knows what he is doing. But we are told. Perhaps Job would have been affronted to learn that it was all to settle an argument between God and Satan. Perhaps we are affronted too. To put Job through all that just to settle a bet? But that is to misunderstand what was going on between the omnipotent Lord and the fallen Angel. A spiritual battle is being waged that we have no reference point for in our modern world.

We love that passage in Ephesians chapter 6 about putting on the whole armor of God, but ignore what the armor is for. “For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms.” (verse 12). Since the Enlightenment in the 17th and 18th Centuries we have seen the world according to different model from that used by the Ancients. We forget that Paul was one of the Ancients who wrote according to that mindset. When he talks about ascending to the third heaven (2 Corinthians 12:2-4) we do not understand. He writes at a time when the third heaven was thought of the sphere beyond the air in the atmosphere and extending to the orbit of the moon. The whole area was suffused with the aether and there aetherial bodies inhabited.

This has no resonance in modern astronomy, but modern astronomy would have meant nothing to Paul. He writes as an Ancient, with an Ancient’s world view, but it was the view of Plato and Aristotle, of all the Biblical writers, of Augustine and all the Church Fathers, of Aquinas, of Chaucer, of Shakespeare, of Milton, even of Shelley. Voltaire and Hume and Descartes have shattered that model. It is, as CS Lewis writes, a discarded image. So ‘spiritual battles in the heavenly realms’ conjure no image for us, any more than the battles of Narnia appear as any more than fairy tales. What we must see is that for all the discarded imagery that Paul uses to bring home their reality to his readers, they are really real. I’m not sure how a modern writer would put it, what metaphors he would use, but we need to be convinced that Satan really is at war with God, that though he is a defeated foe but the battle continues and we will suffer collateral damage if we participate in the war.

For our comfort

The final advantage the Christian has as he suffers is that the Holy Spirit is nigh. To call the Spirit the Comforter misses the change in meaning in the English language. It is not sympathy He brings, but strength; strength to resist the evil one, strength to persevere, strength to go on going on when the going is tough. Sure, He brings all the characteristics of Jesus to stand alongside us, love, kindness, encouragement, patience, longsuffering, peace, joy, goodness, faithfulness and self control, but in this context He brings fortitude, backbone, resilience. As He stands alongside us He recognizes our weaknesses. He restrains the evil one “No temptation has seized you except what is common to man. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you can stand up under it.” (1 Corinthians 10:13)

Paul was troubled by what he called ‘a thorn in the flesh’. We don’t have a clue what it was. Commentators have guessed at epilepsy or some physical deformity. He describes it as a messenger from Satan that tormented him. Despite his prayer (and Paul was an effectual pray-er) the Lord decided to let him keep it; instead he told him that His grace was sufficient for him, for God’s power is made perfect in weakness.

As we suffer we need to pray for more grace. In our weakness God’s power will see us through.

Wednesday, May 13, 2009

I am sorry to have been out of touch for a few days. The side effects of the chemo have kept me from blogging. Last course I had only 4 good days in 14; this time I have determined to do better. So far I have had 6 bad days, but already 3 good days with the prospect of 5 more to come before course 4. But the bad days were bad enough to lay me low.

The cold induced pins and needles were worse this time lasting 6 rather than 4 days, and colic and diarrhea afflicted me yesterday.

We have completed the 1000 piece jigsaw together, though my wife put in more pieces than I did. We are about to start a new one later today.

I have been working on a major article on suffering since the weekend, which I shall publish later this week. I have managed to get Michael Ward's book on Planet Narnia and will start it soon, but I have been working my way slowly through CS Lewis's The Discarded Image: An Introduction to Medieval and Renaissance Literature, which is really a technical book for undergraduates studying that subject - hard going without a training in the Classics.

It has made me aware of the vast canyons of my ignorance, but also that everybody before the Eighteenth Century though from a very different set of assumptions from those that we use today.

Thursday, May 07, 2009

I have just completed the third course of chemo and am waiting for side effects. In order to pre-empt these I have made some changes. Most importantly, I have reduced the dose of dexamethasone from 8, 6, 6, 2, 2 on successive days to 4, 4, 2, 2. The dex was there as an anti-emetic, but I was not sick and the side effects were fluid retention, constipation, hypertension, 5 pounds weight gain, psychiatric symptoms (high as a kite), and sleeplessness. Of these only sleeplessness has remained with the lower dose, but I have been able to rise at 5 am and get on with some work.

I have also purchased some lightweight linen gloves to wear inside to avoid the cold-induced pins and needles caused by the oxaliplatin. I am even typing with them on right now. It's a little bit clumsier and I have to make more use of spellcheck.

I am also conscious this time of acid reflux and have recourse to the Gaviscon. That is perhaps because I have switched back to ranitidine from lanzoperazole. I was worried that a PPI would leave me more at risk from c difficile. I will try switching back while I am on the steroids.

I am having a lie down after meals to try an catch up on sleep. Even 20 minutes seems to help

I find it difficult to read, which is probably the steroids. Instead I am following the narrative for several TV shows including Damages, Lost, ER, 24 and The Wire. I am not sure that I could defend my watching any of these, but for my illness, but at least they pass the time while I'm feeling too unwell to work.

Diane and I have also started a 1000 piece jigsaw puzzle. To do it on, we went out and bought a picnic table with 4 plastic seats attached. The first time we used it a small piece of plastic that was holding it stable snapped and we ended up on our backs (luckily without any of the spars inserted into our anatomy) surrounded by jigsaw pieces. The shop replaced it as faulty and now we are about halfway through the puzzle.

Monday, May 04, 2009

We used to have two May trees (Crataegus mongyna) in our front garden each with flowers of a slightly different pink. Over the past several years, the smaller of the two, the one with flowers of duskier pink, was clearly ailing. Pieces of bark were falling off revealing holes in the trunk, and parts of the tree refused to bear either blossom or leaves. Our gardener was loathe to let anything die so he rigged up a support structure of wooden poles, making it look like an old lady with a walking frame. When the gardener moved away last Fall we took the opportunity to put it out of its misery and had it felled by a troupe of jobbing gardeners led by a formidable lady named Cath.

For the first time this Spring has seen a lonely Hawthorn in the garden. These trees grow to a great age and I have no difficulty in believing that this tree is as old as the house; close to ninety years. It is gnarled and twisted, with a tightly packed jungle of branches and twigs, all equipped with sharp and rigid thorns. It is also infected with wood pigeons. These fat doves with their distinctive coloring and flask of white at the neck are eating something in the trees. It may be an insect, but I suspect it is the flower bud that attracts them. When we were young we used to call the Whitethorn (the same tree has many names; Quickthorn and Haegthorn are others) the bread-and-butter tree and we used to pick the fresh flower buds to chew on them. The pigeons clamber clumsily over the branches making them quiver but, unaware of their precarious balance, they munch steadily at their floral feast.

Appearing on our drives comes Timmie, the ginger Tom from up the street. He is a seldom visitor yet he stalks the place as if his own domain. Now he spots the three wood pigeons in the tree. He saunters on to the lawn and looks lazily up at the birds. The first branch is five feet up and I say to myself, "Bad luck, Timmie, those birds are too tall for you."

He stays watching them munch for several minutes, then suddenly he takes one bound against the trunk and jumps up into the branches. Squirming between the thorns he emerges mid-tree. The pigeons are aware of his presence and off they fly. Timmie disappears and then from among the foliage an orange face appears and lick his lips. Cheshire-like he grins at me before disappearing. It must have been an incident like this that inspired Charles Dodgson, the mathematician.

Sunday, May 03, 2009

Those who are not soccer enthusiasts may not have heard of Sven Goran Eriksson. He was the first non-English manager of the England football club from 2001-2006. He was more successful than some of his predecessors, but never won anything and garnered a lot of adverse publicity from his 'bachelor lifestyle'. After being sacked by England, he managed Manchester City then owned by the billionaire crook who ruled Thailand, and after failing there, he moved on last year to manage Mexico's national team. The results in Mexico were poor and after losing world cup qualifiers against the United States and Honduras, Mexico gave him the bullet on April 2nd.

I saw a reference to a Reuters wire yesterday that said he was now in isolation in a Bologna hospital suffering from flu. Sven flu?

On the other hand when asked whether there would ever be a Black American President one pundit remarked "Pigs might fly."

Obama has been president for 100 days now and what have we got? Swine flew.

Saturday, May 02, 2009

For the last two nights I have woken at 3-30 am and been unable to sleep afterwards. The problem is not that I am unwell, but that after a long period of feeling unwell and poorly able to think clearly, I am feeling to well and my mind has gone into overdrive. Several items popped into my head which may well feature in future blogs.

I spent some time in contemplating how the plot will develop in my nascent novel.

I wrote a verse of a hymn.

I had some thoughts about how to write a paper on the plausibility of treating high risk symptomless CLL.

I gave some time to considering how to bring new treatments more quickly to market.

Person to person transmission of the new virus has been observed in the USA, Germany, Spain and the UK so it is a pandemic. The word 'pandemic' simply refers to the extent of the spread , not the severity. A pandemic is defined by "sustained human transmission within more than one country in separate World Health Organisation regions".

From what has been observed so far this new strain is similar to normal winter flu. But the 1957 pandemic of Asian flu killed 2 million people world wide. It is estimated that flu has a death rate of 1 in 1000, but if many people get it, a lot of people will die.

How then do we explain the death rate of 7+% in Mexico? It is simply a matter of using the wrong denominator. There are 117 million people in Mexico. Are we to assume that among the 117 million, only 1600 have had the new flu? That's nonsense! The overwhelming majority have not had a blood test. One imagines that record keeping is not strong in Mexico. I doubt there is a universal general practice program in Mexico collecting statistics on the incidence of infections as there is in the UK, Sweden and other European countries. They don't even have that in the USA.

I expect that this will be a normal flu virus causing similar symptoms and of similar severity to normal flu. There will be some deaths, there always are, but we have Tamiflu which curtails symptoms. In a few months we will have a vaccine. This looks like being less severe though more widespread than 1957.

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About Me

Born in Worcester, England 1943; school at Farnborough, Hampshire 1954-62; University 1962-7 and junior doctor posts 1967-74 in Bristol; Consultant Haematologist Bournemouth 1974-2003; Professor of Immunohaematology Southampton 1986 to present. Honorary Consultant Haematologist Kings College Hospital, London, 2004-present. After 5 years of working part time researching, writing, reviewing, editing, speaking, sitting on committees, advising, answering questions and thinking, I now think of myself as fully retired apart from my role as Editor in Chief of the medical journal Leukemia Research. I was awarded the Binet-Rai medal for outstanding research in CLL in 2002 and this has been my most sucessful area of research, but I have also made important contributions in the fields of apheresis, stem cell transplantation, myeloma, myelodysplastic syndrome, antibody therapy, cytokine therapy and DNA vaccines. I was once mascot for Aldershot Town Football. Club. Married to Diane for 44 years. Four children, Karen, Richard, Angela and David.